Obesity and its implications for morbidity and mortality after cholecystectomy: A matched NSQIP analysis

Background: The risks from super obesity (SO) following cholecystectomy have not been studied. Methods: NSQIP analysis of patients undergoing cholecystectomy from 2005 to 2011. Non-obese (NO) patients (BMI 18.5-30) were matched 1: 1 by age, sex, race and comorbidities to morbidly obese (MO) (BMI 35-50), and separately to SO (BMI >= 50) individuals. Clavien 4 complications and 30-day mortality were compared. Results: 13780 MO and 1410 SO patients were matched to NO patients. Obese patients were more likely to present with chronic (CC) rather than acute cholecystitis (AC). Compared to NO patients, Clavien 4 complications were significantly increased among SO patients overall especially with AC where rate of open surgery was significantly higher. Conclusion: SO patients have an increased risk of serious morbidity after cholecystectomy especially with AC where rate of open surgery remains high. Aggressive recommendation for cholecystectomy to reduce presentation with AC and increase likelihood for laparoscopic surgery may be beneficial in SO patients. (C) 2016 Published by Elsevier Inc.